Friday, 9 May 2014

Adjusting meds, taking therapy

I have now, on advice from a psychiatrist here, and after checking with the Stockholm internet based psychiatric advice service that taking advice from other psychiatrists is not some sort of horrendous faux pas, increased my dose of fluoxetine: from 20mg to 40mg. Hopefully, this deals with the anxiety and depression issues that have gradually returned since I started medicating about 16 months ago.

Right now, I'm 3-4 days into the switchover: I have started noticing effects, but not stabilized yet.

I also have started seeing a psychologist for therapy. It's painful, but aspects of it are helpful as well. My worldview is intrinsically pretty horrifying, and once the basic assumptions my emotional circuits work with show up, the size of my emotional responses no longer are quite as outlandish as I am used to considering them to be.

My worldview, on the other hand, is pretty unreasonable. But this is hard to change, and won't happen in an instance.

I have an appointment with my main psychiatrist in Stockholm already scheduled. My plan for that is to

  1. validate the medication adjustments, possibly talk about further adjustments - depending on how much the fluoxetine increase dulls me off
  2. ask if we can add psychotherapy to my treatment plans. I've done only medication for over a year now, and it helped a lot in the beginning, a little in the middle, and not so much towards the end of the year. It would be ... very nice if I could get to use therapy to help me reshape my worldview so that it is not quite as terrifying.
    Even if it turns out to be difficult to add psychotherapy in my health care plan, I think we will do it. If we have to pay for the therapy sessions ourselves, we can afford to do so, and I'm likely to get some support from my employer's healthcare plans as well.
But right now? Kinda difficult. 
I feel useless. I cannot concentrate. I beat myself up for not doing anything enough. I feel ugly.
Then again, I got rejections on a journal submission and a job application today. So maybe feeling a little bit shitty is not ... entirely unreasonable.

I really should write here more.


  1. Thanks for writing! (And yes, please do write more...)

    Did your psych doc tell you how long it would probably be for you to really feel the effects of fluoxetine? At least it's in your system. Maybe it won't take as long to benefit from the higher dose?

    It really does sound like your taking productive steps by setting up appointments. I think setting up initial and sometimes even continuing appointments for me is sometimes the hardest part. Like I'll give an excuse that I'm too busy or I don't have enough time. But I have to remind myself that things like therapy and psychiatrist visits are a priority and even help improve the quality of time I have.

    When you say your worldview is horrific, do you mean cynical or negative? And do you mean in terms of your health or just in general? I'm not entirely sure about how effective the whole "positive thinking" campaign is, but in my experience, therapists are definitely helpful in shedding light on thinking patterns and how they hurt or help us. I hope your discussion with your main provider goes well and that you can at least try out the psychotherapy. I'm not sure what the system is like in Stockholm. Do you know if you can have a telephone chat with a therapist prior to beginning services to see if you feel compatible with the therapist? Just a thought.

    1. I was supposed to have (mostly) stabilized and be up and running after 2 weeks; which is nice: it's about the same timespan I will still be around Minneapolis and in touch with my therapist.

      As for my somewhat scary worldview… let's see… among the things we established in my last two therapy sessions: nothing is ever perfect, and nothing less than perfection allows me to relax and stop working. I am personally responsible for everything and everyone. nothing I believe, feel, or think is in itself valid: validation and even truth are both external, must be validated from someone else to be OK. nobody could ever love me, and those who actually do may well just be engaged in a ridiculously long-term ruse to fool me into thinking that they do.

      Just to grab a sample. This gets hard for me, since I have a HUGE tendency to block out anything emotionally charged; and even remembering things from other emotional states is a struggle.

  2. Oh okay, thanks for clarifying. I can see how that kind of worldview would be painful to bring up during therapy and work through.... What you are describing kind of sounds aspects of self-esteem as well. It's been awhile since I've experienced anything similar, but I do deal with issues of self-worth and value constantly. I feel like "help" with any of these things is deeply personal and has to be really tailored to the individual. With that said, I hope my questions and/or sharing don't come off as intrusive.

    Do you journal at all? Throughout various points of my life, especially dealing with memory and/or mood issues relating to my self-esteem, I would take daily notes about what triggered a negative thought/emotion. For example, I actually had a whole journal which was specific to urges to self-injure. My therapist at the time gave it to me. I could do anything with this journal: draw out my feelings, scribble, write a relaxing phrase repeatedly and of course, just describe the situation. There were no rules and no judgment. Although it's kind of intimidating to look at a blank page, the ready-to-be-filled-emptiness becomes reassuring over time.

    I know now we all have our gadgets and technology, but there's something to be said for exercising mind-hand activity and going old school with a notebook from the dollar store. I bring this up because I just started journaling again with the sole purpose of getting my thoughts out before bed. Of course when I try to sleep, I have the most ideas racing through so it helps to note them and maybe later sort them out.

    Another benefit to an issue-specific journal is the possibility of sharing any or all parts of it with a therapist. I tend to forget things A LOT- especially when it comes to remembering what upset me three days ago. It might have seemed like the biggest deal ever at the time, but when my appointment comes, I totally blank it out. Go figure, right?

    I know there are journal apps now that log the day and time and allow for pictures, etc. I used those as well, but still prefer my paper! Honestly, whatever works in terms of jotting down inner feelings, I'm a proponent of. I recently read a few pages of a book on journaling as a way to "heal." There was a chapter titled the .79 cent therapist in reference to the journal itself. The author described different techniques and approaches to journal entries. Can't remember the title of the book for the life of me, but if you're interested now or later on, I'll look into it.

    Well, that question and tid bit went a lot longer than I intended....! I don't know. It's just what you're describing sounds unpleasant. I could say, "no that's not true! You do deserve to be loved", etc. But would that completely stop that thinking and change your perspective? Heck no. Reassurance/consolation from others is often very nice...temporarily. But like you said, a worldview shift is going to take some time. So whatever you find that starts getting the process "rolling" - hold onto it and good luck :)


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